Abdominal surgery is required both for diagnostic and interventional techniques within the abdominal cavity. A midline incision is preferred in many cases as it allows for wide access to most of the abdominal cavity. Such a midline incision is a vertical one along the linea alba which connects the left and right side rectus muscles. After the procedure, the midline incision must be closed. While re-approximating the left and right abdominal wall, many techniques can be used to secure them together. One such technique is a layered closure. The layered closure allows for individual layers to be re-approximated and sewn sequentially. The benefit to this approach is that there are multiple lines of suture creating a built-in redundancy. If one suture line breaks, there are other sutures still holding layers of the abdominal wall together. The downside of this technique is that multiple suture lines may have variable degrees of tension. Localized areas of increased tension can create localized areas of tissue necrosis which can put the closure at risk of not healing and ultimately failing. An alternative technique is a mass closure. Mass closures re-approximate the abdominal wall with a single continuous suture. The mass closure approach has the advantage of maintaining consistent pressures throughout. However, if the sole suture line breaks the entire closure will fail.
If a midline incision closure fails it can be devastating. If a hernia forms, that means the closure partially failed and soft tissue extends through the muscular layer creating a bulge of soft tissue. This can cause multiple complications such as strangulation of the bowel, and therefore such hernias need to be repaired. In some instances, there is a defect in both the abdominal muscle and skin. This is known as abdominal wall dehiscence. This is a dangerous condition that has to be repaired and results in death in 30% of patients. If an organ, such as the bowel, extends through the muscle and skin it is known as evisceration. This is an extremely critical condition and needs to be repaired immediately. Risk factors for dehiscence and evisceration are age, collagen disorder, diabetes, obesity, and poor closure techniques. When a midline closure fails, it is often repaired with retention sutures. Retention sutures are reinforced sutures with a tubular structure through which the suture passes that can be partially embedded within the muscular layer. Retention sutures are not preferable in that they do not allow natural healing of the abdominal wall and can cause long term defects.
Recently, surgical meshes have been introduced to reinforce midline incisions to prevent hernia, dehiscence, and evisceration formation. They are placed under the rectus muscle and are sewn to the soft tissue. After the surgical mesh is in place, the overlying layers can be re-approximated and sewn in a traditional manner. While these surgical meshes have shown promise in preventing poor outcomes, they are challenging to put in place. They require additional sutures to be placed which increases procedure time. They also can adhere to themselves or nearby soft tissues. They also require sutures to be placed within the abdominal cavity which requires very difficult surgical maneuvers to be effective. Because of these drawbacks, many surgeons do not elect to place the beneficial and prophylactic surgical meshes. An easier technique would ensure more surgeons would elect to place the meshes resulting in fewer complications. It would also reduce the amount of time to complete the procedure, which would result in significant monetary savings within the health care system. As such, an improved abdominal wall closure device may be desirable.